Nammas Wail, Ajosenpää Iina, Maaniitty Teemu, Stenström Iida, Bax Jeroen J, Knuuti Juhani, Saraste Antti
Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland; Heart Center, Turku University Hospital, Turku, Finland.
Heart Center, Turku University Hospital, Turku, Finland.
Int J Cardiol. 2025 Oct 15;437:133493. doi: 10.1016/j.ijcard.2025.133493. Epub 2025 Jun 8.
The prognostic utility of sequential hybrid imaging strategy (coronary computed tomography angiography (CCTA) followed by positron emission tomography (PET) myocardial perfusion imaging in those with obstruction) in the elderly remains unclear. We explored the predictors of adverse outcome in patients ≥65, versus those <65 years, who underwent hybrid CCTA-PET for evaluation of coronary artery disease (CAD).
Retrospectively, we evaluated 1948 patients (43.8 % ≥65 years) referred for CCTA due to suspected CAD from 2008 through 2016. Patients with obstructive CAD by CCTA (n = 657) underwent O-water PET under adenosine stress.
Mean age was 61.9 ± 9.9 years, 58.9 % were females. Elderly patients had more often obstructive CAD by CCTA, and ischemia by PET. During a median follow-up of 6.7 years, the composite adverse outcome (all-cause death, myocardial infarction, or unstable angina) occurred more often in patients ≥65, versus those <65 years (14.2 % vs. 5.6 %, p < 0.001). Ischemic CAD assessed by hybrid imaging predicted events with a hazard ratio of 5.65 (95 % CI 2.35-13.57) in older patients, and 7.01 (95 % CI 3.08-15.94) in younger patients, compared with patients without CAD. The c-statistic of a multivariable model including the hybrid CCTA-PET finding (adjusted for clinical risk predictors) for predicting the composite outcome was similar between patients ≥65, versus those <65 years (p = 0.1). There was no interaction between age category and the hybrid CCTA-PET finding for prediction of events (p = 0.9).
The prognostic utility of hybrid CCTA-PET for predicting adverse events at long-term follow-up was similar between patients ≥65 and those <65 years.
序贯混合成像策略（冠状动脉计算机断层扫描血管造影术（CCTA），随后对存在阻塞的患者进行正电子发射断层扫描（PET）心肌灌注成像）在老年人中的预后价值仍不明确。我们探讨了年龄≥65岁与年龄＜65岁的患者在接受CCTA-PET混合成像评估冠状动脉疾病（CAD）时不良结局的预测因素。
我们回顾性评估了2008年至2016年因疑似CAD而接受CCTA检查的1948例患者（43.8%≥65岁）。CCTA显示存在阻塞性CAD的患者（n = 657）在腺苷负荷下接受O水PET检查。
平均年龄为61.9±9.9岁，58.9%为女性。老年患者通过CCTA发现阻塞性CAD以及通过PET发现心肌缺血的情况更为常见。在中位随访6.7年期间，年龄≥65岁的患者发生复合不良结局（全因死亡、心肌梗死或不稳定型心绞痛）的情况比年龄＜65岁的患者更为频繁（14.2%对5.6%，p＜0.001）。与无CAD的患者相比，通过混合成像评估的缺血性CAD在老年患者中预测事件的风险比为5.65（95%CI 2.35 - 13.57），在年轻患者中为7.01（95%CI 3.08 - 15.94）。包括混合CCTA-PET检查结果（根据临床风险预测因素进行调整）的多变量模型预测复合结局的c统计量在年龄≥65岁与年龄＜65岁的患者之间相似（p = 0.1）。年龄类别与混合CCTA-PET检查结果在预测事件方面不存在交互作用（p = 0.9）。
年龄≥65岁与年龄＜65岁的患者在长期随访中，混合CCTA-PET预测不良事件的预后价值相似。
